Management of traumatic soft tissue defects with dermal regeneration
template: A prospective study
Jean-Maxime Alet, Romain Weigert, Jean-Claude Castede, Vincent Casoli*
Plastic and Burn Surgery Department, FX Michelet Center, Bordeaux Hospital, Bordeaux Segalen University, Place Amelie Raba Leon, 33076 Bordeaux, France
Traumatic injuries with extensive soft tissue defects require the
search for new materials that may serve as skin replacements for
definitive wound closure. Skin substitutes have been used to
manage these wounds. They should resemble functional and
aesthetic properties of the dermis and the epidermis. A skin
substitute consists of a layer of animal type one collagen serving as
a dermal regeneration template (DRT), and it is covered with an
adherent layer of silicone membrane functioning as a temporary
artificial epidermal barrier. As the dermal regeneration matrix
brings a new vascular layer through the revascularisation of the
template, it should be used in situations where flap cover would
normally be required.
The aim of this study was to evaluate the use of a DRT associated
to a split-thickness skin graft (STSG) to cover severe traumatic
Patients were included with institutional ethical committee
approval requiring written informed consent for follow-up, in
accordance with the Declaration of Helsinki.
Materials and methods
This study was performed in a prospective fashion. Inclusion
criteria included trauma patients between 5 and 65years of age,
with severe traumatic wounds, either open fractures or full-
thickness skin wounds, involving exposure of deep functional
structures, including tendons without paratenon, bones without
periosteum and joints without articular capsule, eligible for an 18
months’ follow-up. Exclusion criteria included life-threatening
conditions, diseases or medications leading to wound healing
Injury, Int. J. Care Injured 45 (2014) 1042–1048
A R T I C L E
I N F O
Accepted 29 November 2013
A B S T R A C T
Introduction: Traumatic soft tissue defect is a common issue for the trauma surgeon. The aim of this study
was to evaluate the use of a dermal regeneration template (DRT) associated to a split-thickness skin graft
(STSG) to cover severe traumatic wounds involving exposure of deep functional structures.
Materials and methods: Patients with severe traumatic defects, either open fractures or full-thickness
skin wounds involving exposure of tendons without paratenon, bones without periosteum or joints
without articular capsule, managed in the authors’ trauma centre, were included in a prospective
fashion. They were treated by DRT, associated to STSG within a month and followed up to 18 months. The
primary outcome was STSG percentage of take at 18 months. The secondary outcomes included
complications rate, functional results, scar retraction rate at 18 months and aesthetic results.
Results: A total of 15 patients were included, with 100% follow-up at 18 months. The mean age was 44.3
years, with nine men. Eighty percent of the wounds were located on the lower limb. After 18 months, the
mean STSG take rate was 99.3%. Between the placement of the template and the STSG procedure, the
reported complications were template unsticking, seroma, local infection and local oedema. There was
no reported haematoma. In terms of functional outcome, percentages of patients undergoing
rehabilitation from the time of the skin graft until the end of the follow-up decreased from 80% to
20%. There was 8.7% of retraction in length, and an 8.2% retraction in width. The Vancouver Scar Scale
score constantly decreased until 2.5 at 18 months. The final functional and aesthetic subjective scores
showed the marks to be located above the ‘Satisfying’ threshold, either by the surgeon or by the patients.
Discussion and conclusion: Eighteen months’ follow-up demonstrated that DRT reconstruction is a
simple, reliable, efficient tool to treat complex traumatic soft tissue defects.
? 2013 Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: +33 556795531; fax: +33 556796163.
E-mail addresses: email@example.com (J.-M. Alet),
firstname.lastname@example.org (R. Weigert),
email@example.com (J.-C. Castede),
firstname.lastname@example.org (V. Casoli).
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0020–1383/$ – see front matter ? 2013 Elsevier Ltd. All rights reserved.
product. It had no involvement in the study design; collection,
analysis and interpretation of data, the writing of the manuscript
or the decision to submit the manuscript for publication.
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